PURPOSE OF THE STUDY Periprosthetic joint infection is a major complication which in most of the cases requires a long-term administration of antibiotics and often necessitates undergoing multiple challenging surgeries. Bacterial adhesion to foreign material is one of the key risk factors associated with periprosthetic joint infection. The foreign material with large adhesion area might be also the UHMWPE (Ultrahigh molecular weight polyethylene) particles released during the wear process from the surface of articulating components. The purpose of this study is to evaluate potential adhesion areas of wear particles in relation to diverse distribution of the size and shapes of wear particles in periprosthetic tissue and to assess an increase in the risk of infectious complications associated with an increase in the adhesion area of wear particles. MATERIAL AND METHODS The size and morphology of model and real UHMWPE particles were determined with the use of light microscopy and scanning electron microscopy. By determining the morphological descriptors, the surfaces of individual particles for different distributions of polyethylene particles were calculated. When measuring the model wear particles, 6 model situations were simulated, in which comparisons with the control measurement by the BET (Brunauer-Emmet-Teller) method were made. RESULTS The variability of individual morphological descriptors demonstrates the effect on the total surface of particles. The calculated coefficient defines how many times the particle surface increases when corrected to the given descriptor (elongation, flattening, roughness, porosity). The total area of real wear particles at 1 year is 4,622 cm2, at 20 years it is 92,440 cm2. Based on our calculations, the area of particles where a biofilm is actually formed (approximately 50 bacteria may adhere to a particle of 3µm in diameter) is 809.5 cm2 at 1 year and 16,190 cm2 at 20 years. DISCUSSION According to the measurements, the size of the potential adhesion area of metal parts and polyethylene particles becomes equal already after several weeks of endoprosthesis usage and after a few years it is many times larger. The question is whether the risk of bacterial adhesion, i.e. also the risk of infectious complications of TEP actually increases. The clinical practice suggests that the number of infections e.g. 10, 15 or 20 years after the primary implantation is not statistically higher, despite the confirmed growth of potential adhesion area in the form of UHMWPE particles. This fact could be explained by a partially equal regulatory pathway of infection and polyethylene disease. The immune system stimulated by wear particles might better resist the hematogenic infection. CONCLUSIONS The study outcomes clearly indicate that the area of polyethylene wear particles considerably increases over time. In spite of the fact that only approximately 10% of wear particles show parameters (also with respect to the size of particles and bacteria) for potential bacterial adhesion, this area is many times larger than the area of metal parts of the endoprosthesis. Key words: UHMWPE particle, adhesion, biofilm, wear, TJR infection.
- MeSH
- artroplastiky kloubů škodlivé účinky přístrojové vybavení MeSH
- infekce spojené s protézou etiologie MeSH
- lidé MeSH
- polyethylen škodlivé účinky MeSH
- polyethyleny škodlivé účinky MeSH
- protézy a implantáty škodlivé účinky MeSH
- selhání protézy * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Considered to be one of the most common causes of aseptic loosening of endoprostheses is the THA failure due to the wear of articulating components, UHMWPE in particular. The purpose of this study is to verify, in terms of oxidative damage and other parameters, the differences between the UHMWPE implants made by various manufacturers explanted for aseptic loosening with the same life span in vivo. MATERIAL AND METHODS In the period 2010-2015, a total of 21 THA articulating components (cups) made of Ultrahigh molecular weight polyethylene by seven different manufacturers were explanted. For each manufacturer, three UHMWPE cups with the same life span (10-12 years after the primary implantation) were evaluated. The damage to the examined joint replacements was described in complexity using three different criteria, namely independently by three evaluators - experienced orthopaedic surgeons. The evaluated criteria were the following: degree of osteolysis determined based on the preoperative radiographs, wear rate of the explanted UHMWPE component, and extent of perioperatively detected granuloma. Oxidative damage and other structural characteristics of explanted cups were studied by means of infrared spectroscopy and microhardness testing. The correlation between the clinical orthopaedic assessment and oxidative damage were statistically processed. RESULTS Strong correlations between the oxidative damage and crystallinity, strong correlations between all types of orthopaedic assessments, negligible correlations between trans-vinylene index and all the other quantities, and moderate correlations between the oxidative damage and clinical evaluation were identified. It was confirmed by experimental measurement that the observed high oxidative damage, resulting in increased crystallinity, manifested itself also in micromechanical properties of the material at the respective site of the THA articulating component. DISCUSSION The discussion includes the comparison of correlations of individual quantities as well as potential effects on the differences in values of components made by individual manufacturers. The values are related to the data in literature and generally accepted claims. CONCLUSIONS At the time of failure almost all the components showed severe or even critical oxidative damage that strongly correlated with the overall clinical evaluation of the damage to the implant. This confirmed that the oxidative degradation is one of the main causes of THA failure. Key words: UHMWPE, oxidation index, crystallinity, THA failure, wear.
- MeSH
- kyčelní protézy * škodlivé účinky MeSH
- lidé MeSH
- náhrada kyčelního kloubu přístrojové vybavení MeSH
- odstranění implantátu MeSH
- polyethyleny * škodlivé účinky MeSH
- protézy - design MeSH
- selhání protézy etiologie MeSH
- testování materiálů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- MeSH
- kostní cementy terapeutické užití MeSH
- kyčelní protézy * dějiny normy MeSH
- lidé MeSH
- náhrada kyčelního kloubu dějiny metody přístrojové vybavení statistika a číselné údaje MeSH
- polyethyleny škodlivé účinky terapeutické užití MeSH
- polytetrafluoroethylen škodlivé účinky terapeutické užití MeSH
- pooperační komplikace epidemiologie etiologie MeSH
- selhání protézy etiologie MeSH
- tření MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- historické články MeSH
- přehledy MeSH
Závěrečná zpráva o řešení grantu Interní grantové agentury MZ ČR
26 l., 97 l. : il., tab. ; 31 cm
Osteolysis(OL) is considered a major cause of hip arthroplasty failure. The exact underlying pathogenetic mechanisms are yet to be elucidated despite the relationships with wearing of PE prosthetic surfaces are generally accepted. PE wear particles activate an inflammatory cascade in which several cytokines play a pivotal role resulting in OL. However, severe OL does not develop in every case under similar conditions (i.e. number and size of PE particles). This suggests existence of important endogenousfactors influencing the OL onset/development. Concept of implication of cytokine gene polymorphisms seems to be one of the most attractive because of the key role of cytokines in regulation pathways. The aim of the project is to test hypothesis that there exists association between cytokine polymorphisms and extension of bone defects. Scope of the project is in line with the up to date trends in both orthopaedics and immunology.
Osteolýza (OL) je považována za největší problém endoprotetiky kyčelního kloubu. Jde o multifaktoriální proces související s opotřebováním kloubních povrchů implantátu (nejčastěji polyetylénu, dále PE). V patogenezi OL sehrávají klíčovou úlohu makrofágy,osteoblasty, osteoklasty a plejáda cytokinů, z nichž nejdůležitější jsou TNF?, IL-1ß, IL-6. Závažná osteolýza se ale nerozvíjí u všech případů vystavených srovnatelnému počtu PE částic. Předpokládá se proto existence endogenních faktorů, které o dispozici k této komplikaci rozhodují. Jedním z nich je rozdílná aktivita cytokinů daná variabilitou genů, které je kódují (genový polymorfismus =GP). Cílem projektu je testování hypotézy, že existuje významná asociace mezi vybranými typy GP cytokinů a rozsahemOL. Zaměření projektu odpovídá trendům v ortopedii i imunologii.
- MeSH
- cytokiny MeSH
- diagnostické techniky molekulární MeSH
- náhrada kyčelního kloubu MeSH
- polyethyleny škodlivé účinky MeSH
- polymorfismus genetický MeSH
- rizikové faktory MeSH
- Konspekt
- Biochemie. Molekulární biologie. Biofyzika
- NLK Obory
- ortopedie
- biologie
- NLK Publikační typ
- závěrečné zprávy o řešení grantu IGA MZ ČR
The contribution deals with analysis of total hip endoprosthesis articulation surface wear. Endoprosthesis wear is scanned with coordinate-measuring machine CONTURA G2 RDS from Carl Zeiss. Th e computer model created from measured data is compared with computer model constructed on the basis of the producer drawing documentation. Obtained data include wearing analysis of whole articulation surface and focus to the critical wearing zones.
- MeSH
- financování organizované MeSH
- kyčelní protézy škodlivé účinky MeSH
- lidé MeSH
- mikroskopie atomárních sil metody přístrojové vybavení využití MeSH
- náhrada kyčelního kloubu škodlivé účinky MeSH
- počítačová rentgenová tomografie metody přístrojové vybavení využití MeSH
- počítačové zpracování obrazu metody přístrojové vybavení využití MeSH
- polyethyleny škodlivé účinky terapeutické užití MeSH
- zobrazování trojrozměrné metody přístrojové vybavení využití MeSH
- Check Tag
- lidé MeSH
Od roku 1962, kdy sir John Charnley začal používat při náhradě kyčelního kloubu jamku z vysokomolekulárního polyetylenu, došlo k základnímu zvratu v osudu pacientů s těžkým artrotickým nebo revmatickým postižením kyčelního kloubu.
- MeSH
- artroplastiky kloubů metody přístrojové vybavení využití MeSH
- biomedicínské a zubní materiály terapeutické užití MeSH
- finanční podpora výzkumu jako téma MeSH
- lidé MeSH
- lubrikace MeSH
- polyethyleny dějiny škodlivé účinky terapeutické užití MeSH
- protézy a implantáty trendy využití MeSH
- Check Tag
- lidé MeSH
- MeSH
- dyspnoe diagnóza etiologie terapie MeSH
- echokardiografie MeSH
- farmakoterapie metody MeSH
- klinické laboratorní techniky statistika a číselné údaje MeSH
- lidé MeSH
- plicní tuberkulóza chirurgie MeSH
- počítačová rentgenová tomografie MeSH
- polyethyleny aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- respirační insuficience etiologie radiografie terapie MeSH
- torakotomie metody škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
Acta orthopaedica Scandinavica, ISSN 0300-8827 ; Supplement Vol. 68. 276
26 s. : il. ; 24 cm
